Transfusion requirements and immunohematologic complications in orthotopic liver transplantation
Uzuni A, Nagai S, Yoshida A, Abouljoud M, and Otrock ZK. Transfusion requirements and immunohematologic complications in orthotopic liver transplantation. Transfusion 2019; 59:218A.
Background/Case Studies: Orthotopic liver transplantation (OLT) has been associated with major blood loss and consequently high blood transfusion requirements. We aimed to determine the transfusion needs and immunohematologic complications in OLT at our institution. Study Design/Methods: This was a retrospective study performed at a single large academic medical center. The study was approved by our Institutional Review Board. Electronic medical records and blood bank files of 229 consecutive patients who underwent OLT over a 2-year period were reviewed. Results/Findings: The median age of patients was 54.8 years (range, 17.6-74.6); 151 (66%) were male. Patients received a median of nine red blood cell (RBC) units (range, 1-86), three platelet units (range, 1-30) and 14 fresh frozen plasma units (range, 1-92). Only 15 patients did not receive RBCs perioperatively. Nine patients (3.9%) had a positive antibody screening test before transplantation: anti-E (one), anti-E and anti-Fya (one), anti-E and anti-K (one), anti-D (two), anti-D and anti-Fya (one), anti-K (one), anti-Jka (one), and anti-c (one). Serologic follow-up with antibody screen was available for 192 (83.8%) with a median follow up of 23 days (range, 2 days-130.1 mos). Five patients (5/192; 2.6%) had alloimmunization after transfusion: anti-E (two), anti-K (one), anti-K and anti-Jkb (one), anti-Jkb (one); these five patients received 5, 7, 10, 14, and 17 units of RBCs perioperatively. D-positive RBC units (median, 3 units; range, 1-9) were transfused to five D-negative patients; none of these patients developed a positive antibody screening test after a median serological follow up of 21.2 months (range, 17 days-79.4 mos). One patient had a positive DAT of unknown origin and without clinical significance. Conclusions: Despite improvement with blood conservation techniques, our study showed that transfusion requirements in OLT remained high. However, the incidence of alloimmunization was low (2.6%) and it was absent for the D antigen in D-negative patients receiving D-positive RBC.